Are Instagram Communities Promoting Eating Disorders?

According to the National Institutes of Health, anorexia nervosa has the highest mortality rate of all the mental disorders. This rate is even above that for depression. It has been estimated that 10 percent of those with anorexia die, with estimates increasing to 20 percent for those who do not receive treatment. Mortality rates in bulimia are about 4 percent for those who engage in binging and purging behavior. Eating disorders have severe, and sometimes life-threatening, medical complications. Severe problems associated with starvation and purging include bone disease, heart complications and heart failure, digestive tract distress, infertility, electrolyte imbalance, chronic pain, stomach and esophagus rupture, kidney failure and anemia among others. Chronic starvation coupled with binging and purging can damage every organ of the body.

Yet those with eating disorders are strangely attached to the behavior despite the obvious medical complications. This makes them among the patient groups most resistant to treatment. Efforts to improve treatment outcomes have focused on increasing motivation for treatment. Many have spoken about the delusional and obsessive qualities involved in eating disorders which helps maintain beliefs that the individual does not have a problem and the behavior is actually positive. Social media sites that have developed over the past several decades have become havens for people with eating disorders and pro-eating disorder communities have formed where those who don’t want to get rid of their disordered eating can find like minded- individual, support, and content that reinforces their delusional thinking.

Pro-Eating Disorder Hashtags

Pro-eating disorder (pro-ED) communities on social media sites have become increasingly problematic in an effort to allow free speech without external censorship. Yet this has also led to communities which encourage and reinforce the adoption and continuation of disordered eating habits as acceptable alternative lifestyles as opposed to serious threats to health. Starting in 2012, in an effort to stem some of this activity, Instagram, the photo-sharing social media site, began making eating disorder related terms unsearchable. They did this in order to prevent users from being able to go directly images believed to be shocking or posts thought to possibly encourage the idea that eating disorders are a viable lifestyle choice as opposed to a mental illness.

In order to examine whether these efforts were effective, researchers at the Georgia Institute of Technology designed the first large-scale quantitative study investigating the effects of Instagram’s attempt at moderation of pro-ED communities on the site (Chancellor, Pater, Clear, Gilbert & De Choudhury, 2016). The study examined over 2.5M posts over the course of three years. Findings indicated that not only had proliferation of pro-eating disorder posts not decrease but that the pro-ED community had avoided moderation by using non-standard lexical versions of moderated hashtags to get around the restrictions. Over the three years of the study, investigators found that the lexical variations of moderated terms became more complex.

It also appeared that the attempts at moderating these communities may have had the opposite effect. Pro-eating disorder communities that utilized the lexical variations showed an increase in participation and support of pro-Eating Disorder content by as much as 30 percent. Additionally, over time the variant hashtags related to pro-eating disorder content communicated more toxic, self-harm, and vulnerable messages. It became clear that despite Instagram’s efforts, that pro-ED communities continued to thrive and if anything, the attempts at moderation possibly contributed to increased activity and severity.

After this study, Tumblr and Pinterest took Instagram’s efforts a step further, banning all pro-eating disorder content. This coincided with the activity of pro-eating disorder communities on Instagram exploding, likely related to users whose content had been banned on other sites migrating to Instagram. Instagram continued to attempt to address the situation by moderating tags. Terms like #starve and #purge either showed no results or displayed a warning stating:

“Posts with words or tags you’re searching for often encourage behavior that can cause harm and even lead to death.”

This was followed with the added message that encouraged users to get help. Despite this, users could still access problematic content if they clicked through. Other obvious hashtags like #skinnyinspiration and #thinspire displayed no warning message and took users to images of emaciated women. Many continued to criticise the site, saying such content glorified the romantic notion of eating disorders and associated concepts of self harm.

This past April, additional hashtags were banned. Guidelines released with the ban of the hashtags #thinspo and #thinspiration read:

"Don’t promote or glorify self-harm. While Instagram is a place where people can share their lives with others through photographs, any account found encouraging or urging users to embrace anorexia, bulimia, or other eating disorders; or to cut, harm themselves, or commit suicide will result in a disabled account without warning. We believe that communication regarding these behaviors in order to create awareness, come together for support and to facilitate recovery is important, but that Instagram is not the place for active promotion or glorification of self-harm."

Now, a new BBC investigation found that certain terms promoting bulimia are still searchable on Instagram. They also discovered that the Instagram search bar actually suggests alternative spellings and phrasings for known and recognizable terms which many have criticized, believing they glamorize or encourage eating disorders. In one case, investigators discovered that the search box offered 38 alternative spellings of a popular term (BBC Trending, 2018, December 12).

After the BBC investigation which questioned whether some of Instagram’s hashtags may promote eating disorders, the social media site has put certain additional related hashtags on an unsearchable list. They’ve tried to become more savvy about hashtags after the investigation determined that many users were managing to find ways around the platform’s filters. In response, they’ve taken steps to add health warnings to several popular terms that refer to eating disorders that have alternative spellings. Other hashtags, when searched, will trigger a pop-up asking the user if they need help, with options to "learn more", cancel the search, or view content anyway.

Instagram’s rules prohibit content that "promotes or glorifies eating disorders" and the company says it will continue to develop its safety policies.

"Experts we work with tell us that communication is key in order to create awareness, and that coming together for support and facilitating recovery is important," a company spokesperson said.

One of Many Problems Related to Pro-Eating Disorder Support Groups

While it is a positive thing that Instagram is attempting to limit the ability for users to be sent to sites that may promote eating disorders, it is clear that limiting tags is not enough. We live in a technological savvy world and many people know enough to get around hashtags. This is a big problem for the Eating Disorder community in particular, as they are very invested in continuing their disordered eating habits and are driven to find supportive communities of people with similar characteristics. If the content and community exists, there will have to be some tags or identifying elements attached to it and eventually those who are looking for will be able to access the information and the members. The myriad of ways this can increase the severity of eating disorder symptoms is beyond the scope of this discussion.

However, one problem does bear mentioning. Those with eating disorders do not want to give them up as they rely on them for a variety of reasons. Those with eating disorders are usually very bright, capable, imaginative individuals. While these are wonderful characteristics outside of the eating disorder symptoms, they also give the person the resources to determine how best to hide the problem for others who want to get them into treatment. The timing of when to put people with eating disorders into group therapy has always been very carefully handled in clinical settings. This is because patients tend to teach each other their tricks for preventing treating providers, friends and family members from realizing they are continuing to lose weight while making it seem as if they aren’t.

People with eating disorders are often terrified of regaining the weight and being forced to let go of the eating disorder. While most would say the symptoms of these disorders are maladaptive, on some level they are providing something for the person, an ability to cope with things in their lives when they don’t know any other way. The dynamics of how eating disorders develop, what maintains them, what help them commit to treatment and all the other factors related to these disorder are incredibly complex and often difficult to determine. It is important to realize that pro-eating disorder groups online or offline can be incredibly harmful and potentially deadly to people with severe eating disorders.

In the absence of positive reinforcement and support for eating disorder behavior, it is difficult enough to help these people in a way that enables them to reclaim their lives. The message that these behaviors are positive choices, ways of exercising control, or will turn the person into the physical embodiment of some romanticized ideal may make it impossible for the person to gain the motivation to seek therapy and be cured.

One of Many Problems Related to Pro-Eating Disorder Support Groups

While it is a positive thing that Instagram is attempting to limit the ability for users to be sent to sites that may promote eating disorders, it is clear that limiting tags is not enough. We live in a technological savvy world and many people know enough to get around hashtags. This is a big problem for the Eating Disorder community in particular, as they are very invested in continuing their disordered eating habits and are driven to find supportive communities of people with similar characteristics.

If the content and community exists, there will have to be some tags or identifying elements attached to it and eventually those who are looking for will be able to access the information and the members. The myriad of ways this can increase the severity of eating disorder symptoms is beyond the scope of this discussion.

However, one problem does bear mentioning. Those with eating disorders do not want to give them up as they rely on them for a variety of reasons. These individuals are usually very bright, capable and imaginative. While these are wonderful characteristics outside of the eating disorder symptoms, they also give the person the resources to determine how best to hide the problem for others who want to get them into treatment.

The timing of when to put people with eating disorders into group therapy has always been very carefully handled in clinical settings. This is because patients tend to teach each other their tricks for preventing treating providers, friends and family members from realizing they are continuing to lose weight while making it seem as if they aren’t.

People with eating disorders are often terrified of regaining the weight and being forced to let go of the eating disorder. While most would say the symptoms of these disorders are maladaptive, on some level they are providing something for the person, an ability to cope with things in their lives when they don’t know any other way. The dynamics of how eating disorders develop, what maintains them, what help them commit to treatment and all the other factors related to these disorder are incredibly complex and often difficult to determine. It is important to realize that pro-eating disorder groups online or offline can be incredibly harmful and potentially deadly to people with severe eating disorders.

In the absence of positive reinforcement and support for eating disorder behavior, it is difficult enough to help these people in a way that enables them to reclaim their lives. The message that these behaviors are positive choices, ways of exercising control, or will turn the person into the physical embodiment of some romanticized ideal may make it impossible for the person to gain the motivation to seek therapy and be cured.

Instagram bans #Thinsperation content

A Personal Response to Instagram's Content Policy

In my opinion, trying to make it difficult for people to search and find this type of content may seem like a positive and responsible strategy on the surface but truthfully it seems more of a cop out. It is clearly insufficient to prevent people who are already vulnerable from finding material and support that might make matters worse. If sites are doing this only because of potential fallout due to recent studies that have criticized them, then they are potentially actively doing harm to some of their readers. If they truly believe that the content is a problem, one that is potentially dangerous, and are trying to limit access to it through search functions, while they may understand there’s a problem, they don’t appear willing to do much to stop it.

There has been no public statement as to why a site like Instagram after years of investigations which demonstrate that their strategy of censoring hashtags is ineffective and even results in more content and community growth would not be willing to do more. Their statement about communication being needed to create awareness, and the role of support in facilitating recovery, is misleading. This may be true for communities that help those recovering from a disorder or problem and many other communities but not those that are promoting dangerous and destructive behavior. Their reasons for their current policy even in light of the newest BBC investigation report remains unclear. Perhaps they are too worried about fallout from users and external supporters of these communities to do more than the minimum to assuage detractors. Or perhaps they’re afraid that they will be criticized for censoring content when their policy is to be relatively hands off.

It is understandable that social media sites want to ensure that they remain open to multiple viewpoints and don’t become known for censorship. Yet when those viewpoints are possibly dangerous to a large number of people both on and off the site, they have a responsibility to determine the best way of preventing such harm. In some cases it may be limiting who has access to certain communities, some kind of oversite or expert third party consultation and recommendations or other types of oversight and review. Yet in some cases, it may mean getting rid of the content and shutting down the community.

While no social media site wants to do this because of the potential backlash, sometimes it may be necessary and the only ethical way to prevent additional risk to its users. The site can get on top of any possible negative reaction by having the owners and managers the site owners and managers create a well thought out public response to potential protestors. This response should incorporate external, third party, empirical research and expert opinions that can be put out at the same time action is taken. This can help mitigate negative fallout from such a action.

But no matter what a sites Terms of Service may be, or what may be stated policy for the site or specific communities we should be responsible and compassionate human beings first. This means when we know something we are providing for the public to use is potentially causing harm we do something to protect those we serve. In cases where there is a high risk of harm occurring, we should be willing to take action even when individuals in the affected communities may not want to be protected and even when we may have to defend our actions to loud and public critics.

This content is for informational purposes only and does not substitute for formal and individualized diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed medical professional. Do not stop or alter your current course of treatment. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.

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AUTHOR

Natalie Frank

8 months agofrom Chicago, IL

You're right about how influencers can make things worse, Melissa. It seems like sometimes organizations, social media, politicians etc. feel need to not say or do anything with regard to communities they are somehow responsible for that might upset others even when these others might be doing things that are harmful. Instagram has taken a lot of flak over this and similar issues so if nothing else, I hope the potential damage to their reputation will get them to more fully address it. Thanks for stopping by and for commenting.

Melissa Clason

8 months agofrom Fayetteville, NC

I've seen a couple of these "pro-ana" posts and I think they're really dangerous, especially when a popular influencer with a lot of followers posts them. I really hope Instagram does something about that, like addressing it in their Terms of Service.

AUTHOR

Natalie Frank

8 months agofrom Chicago, IL

Eating disorders are terrible, Pamela. I think Instagram needs to better address their content despite efforts to make it harder to find. It shouldn't be there in the first place. Thanks for stopping by and for the comment.

AUTHOR

Natalie Frank

9 months agofrom Chicago, IL

I agree, Liz. Just because you ban certain tags doesn't mean people won't still find the content. Thanks for reading and for stopping by.

Pamela Oglesby

9 months agofrom Sunny Florida

I certainly agree that any eating disorders are awful, and this article certainly explains the danger clearly. It is good I guess that Instagram is trying to help but I don't see them being particularly successful.

Liz Westwood

9 months agofrom UK

You raise a very valid and interesting point. Eating disorders can be deadly, as you point out. Any platforms that leave themselves open to being used to spread the word, need more strenuous policing.

AUTHOR

Natalie Frank

9 months agofrom Chicago, IL

True, Flourish. They need to get rid of the actual communities to begin with like other social media sites already have. Then they create a culture where users report content that slips through or new communities that spring up. Eating disorders are terrible conditions and so difficult to get rid of. Sites that suggest they are healthy lifestyle choices and provide support for them have the potential to do great harm. Thanks for stopping by and for the comment.

FlourishAnyway

9 months agofrom USA

What you profile here is really disturbing behavior but unsurprising. If they were really serious the platform could disable the account after a warning. However, the users would probably find some creative way around that.

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